A diagnostic, monitoring, and predictive tool for patients with complex valvular, vascular and ventricular diseases

Abstract

Hemodynamics quantification is critically useful for accurate and early diagnosis, but we still lack proper diagnostic methods for many cardiovascular diseases. furthermore, as most interventions intend to recover the healthy condition, the ability to monitor and predict hemodynamics following interventions can have significant impacts on saving lives. Predictive methods are rare, enabling prediction of effects of interventions, allowing timely and personalized interventions and helping critical clinical decision making about life-threatening risks based on quantitative data. In this study, an innovative non-invasive imaged-based patient-specific diagnostic, monitoring and predictive tool (called C3VI-CMF) was developed, enabling quantifying (1) details of physiological flow and pressures through the heart and circulatory system; (2) heart function metrics. C3VI-CMF also predicts the breakdown of the effects of each disease constituents on the heart function. Presently, neither of these can be obtained noninvasively in patients and when invasive procedures are undertaken, the collected metrics cannot be by any means as complete as the ones C3VI-CMF provides. C3VI-CMF purposefully uses a limited number of noninvasive input parameters all of which can be measured using Doppler echocardiography and sphygmomanometer. Validation of C3VI-CMF, against cardiac catheterization in forty-nine patients with complex cardiovascular diseases, showed very good agreement with the measurements.prediction of effects of interventions, allowing timely and personalized interventions, and helping critical clinical decision making about life-threatening risks based on quantitative data.The heart resides in a sophisticated vascular network whose loads impose boundary conditions on the heart function 6,7,14-16 . Effective diagnosis and prediction hinge on quantifications of the global hemodynamics (heart workload) and of the local hemodynamics (detailed information of the dynamics of the circulatory system, e.g., flow and pressure) of the cardiovascular system as all are very important for long-term health of the heart 6,14,16 . However, there is no method to invasively or noninvasively quantify the heart workload (global hemodynamics) and to provide contribution breakdown of each component of the cardiovascular diseases. Moreover, current diagnostic methods are limited and cannot quantify detailed information of the flow dynamics of the circulatory system (local hemodynamics). Although all of these can provide valuable information about the patient's state of cardiac deterioration and heart recovery, currently, clinical decisions are chiefly made based on the anatomy alone. To augment anatomical information, cardiac catheterization is used as the clinical gold standard to evaluate pressure and flow through heart and circulatory system but it is invasive, expensive, high risk and therefore not practical for diagnosis in routine daily clinical practice or serial follow-up examinations 17 . Most importantly, cardiac catheterization only pro...

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

“…We developed an innovative image-based computational fluid dynamics framework to quantify: (1) metrics of circulatory function (global hemodynamics); (2) metrics of cardiac function (global hemodynamics) as well as (3) cardiac fluid dynamics (local hemodynamics) in patients with C3VD in both pre and post TAVR states. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm that allows for the analysis of any combination of complex valvular, vascular and ventricular diseases 24 , and a 3-D strongly-coupled fluid–solid interaction (FSI) (Fig. 1 : schematic diagram; Fig.…”

“…2 : algorithm flow chart; Table 1 ). Calculations of this computational fluid dynamics framework were validated against clinical cardiac catheterization data 24 and Doppler echocardiographic measurements (Figs. 3 and 4 ).…”

“…We developed an innovative non-invasive image-based patient-specific diagnostic, monitoring and predictive computational-mechanics framework for Complex valvular-vascular-ventricular diseases (C3VD) . For simplicity, this C3VD computational mechanics framework is called C3VD-CMF, described in details elsewhere 24 . C3VD-CMF enables the quantification of (1) details of the physiological pulsatile flow and pressures throughout the heart and circulatory system; (2) heart function metrics, e.g., left ventricle workload and instantaneous left ventricular pressure, etc.…”

“…We used the clinical data of eleven patients with C3VD in both pre and post TAVR conditions (twenty-two cases) not only to validate the proposed framework but also to demonstrate its diagnostic abilities by providing novel analyses and interpretations of clinical data. The validation was done against clinical cardiac catheterization data 24 and clinical Doppler echocardiographic measurements.…”

The Effect of Beta-Blockers on Hemodynamic Parameters in Patient-Specific Blood Flow Simulations of Type-B Aortic Dissection: An Virtual Study

“…The WSS can lead to dissection progression (FL progression), redissection, forming plaque in arteries, or aneurysm formation and reoperation; therefore, BBs and other related drugs are prescribed to minimise elevated WSS and prevent surgical or endovascular repair [4,5,11,20,21,24]. Therefore, by having a meaningful understanding of WSS data and other WSS indices, i.e., oscillatory shear index (OSI) and highly oscillatory, low magnitude shear (HOLMES) [25] in the absence and presence of BBs can be used as a blueprint for clinicians in their decision-making process.…”